Wednesday, May 22, 2024

IVF Medication

Obtaining and Administering IVF Medication

Given that majority of our patients come from abroad, we make sure that their treatments run as smoothly as possible so that there is no added stress factor to the already nervous treatment procedure.

For this end, we collaborate with a number of prestigious doctors and test/scan centers all over the world so that your initial testing and scans can be carried out locally at your own convenience.

Based on your test results, we are able to provide you with our feedback and treatment recommendations. Only then, we are able to provide you with a treatment plan.

Places where you can have your initial testing done are listed in our “Local Consultants” section.

Once we are able to make an assessment, we will provide you with a prescription so that you can obtain your medication either locally or via the international pharmacy that we work with. The international pharmacy can deliver medication worldwide, so you will be able to receive your medication via post within 5-15 days of your order depending on your location.

In urgent cases, we can use a local agent to ship medication from Cyprus, which takes approximately 3-4 days to receive. The cost of medication tends to be cheaper in Cyprus compared to other EU countries, therefore, this option can also help our patients minimize their expenditures.

It will be important to purchase your medication at least 2 weeks prior to your anticipated program start date so that there is enough time for your IVF medication to arrive in time to begin treatment. Once your medication arrives, it will be a good idea to review your treatment calendar a few days before you actually begin treatment so that there is enough time to ask us any questions you may have about medication use.

There will be guidelines in your treatment calendar on how to use your medication. Depending on your treatment program, you will be required to use tablets, injections or both. Tablet use is very straightforward, but the injection administration requires that you are familiar with the injection area and that you learn how to administer the injection.

Below is a list of most commonly used IVF medication at our IVF unit along with their purpose of use:

Estradiol valerate 2 mg (Progynova  / Estrofem)
This is a tablet used to help build a thick endometrial layer in order to prepare the uterus for a successful pregnancy in IVF treatments using donor eggs. The tablets should be swallowed with a drink. They can be taken either with or without food. Your tablets should be taken at around the same time each day. If you forget to take a dose and it is less than 6 hours late, you should take the missed dose and then take your next dose at your usual time. If you forget to take a dose and it is more than 6 hours late, just leave out that dose and take your next dose as usual when it is due.

Lucrin/Lupron/Prostap 3.75 mg depot injection
Prostap injection is a down-regulation agent, which puts your ovaries in a pseudo-menopausal state in order to give us more control over ovulation induction when your IVF treatment begins. This medication can be used in self cycles or donor cycles, depending on how regular menstrual cycles are and the patient’s own ovarian function.

Prenatal vitamin complex (Pregnacare / Elevit)
Taken one tablet daily either prior to starting treatment or when you start treatment.  Prenatal vitamins aim to provide the necessary vitamins and nutrients to your body in necessary amounts. If you miss a dose, leave out the missed dose and do not take more than one tablet at any time.

Doxycycline 100 mg tablets (Doxycycline / Monodox)
These are also tablets used orally- one tablet in the morning and one tablet at night. These are anbtibiotic tablets used as a precautionary measure against a possible uterine infection that may not be visible during a scan.

Prednisolone 5 mg tablets
These are corticosteroids which provide a mild immunosuppression to minimize the risk of embryo rejection. Approximately 15 mg will be used prior to and post embryo transfer to aid with implantation.

Crinone gel 8%
We prescribe crinone gel for progesterone supplementation starting mid cycle. This is to mimic the natural progesterone release which naturally takes place during mid cycle. Progesterone supplementation should be used in all IVF treatments (self cycles or donor eggs). Crinone gel is a vaginal gel which is used twice daily. Cyclogest or other alternatives can also be used if crinone gel is not available in your country. Please contact us for dosing information.

Low molecular weight heparin (Clexane 20 mg/0.2 ml)
LMWH is an anticoagulation drug which helps fight against blood clotting. This is used in patients with high risk of miscarriages.

If you are undergoing IVF treatment where you will be using your own eggs, you will be required to use medication in the injection form as well as tablets. Below is a list of medication used specifically in IVF cycles where patients are using their own eggs:

Femara 2.5 Mg tablets (Letrezole)
Femara is a letrezole preparation. Letrezole is an aromatase inhibitor and works by reducing the amount of estrogen production and blocks the negative feedback mechanism between the ovaries and the brain, allowing a greater response to ovulation induction via FSH/LH. Femara comes in tablets and it is used as one tablet in the morning and one tablet in the evening. This is a medication used for women cycling with their own eggs.

Gonal-F 450 iu vials
Gonal-F is a recombinant FSH preparation which helps develop multiple follicles in the ovaries in an IVF cycle. We prescribe Gonal-F 450 vials instead of the pen due to cost advantage. When you start injection Gonal-F, you will need to use the syringe to measure your exact dose to be administered and leave the remaining dose in the vial to be used the next day. Please be consistent with the timing of your injections. For example, if you inject at 9 AM, keep the injection time consistent for the rest of the days. Below is a link for a video which shows how Gonal-F can be used.

Menopur 150 iu ampoules
Menopur is a human menopausal gonadotropin preparation which contains both FSH and LH activity. We introduce Menopur after Gonal-F in order to aid with oocyte maturation by incorporating LH activity similar to when it starts to release naturally. It is also administered sub-cutaneously, similar to Gonal-F. You can use your gonal-f syringes to administer Menopur.

Cetrotide 0.5 mg injections
Cetrotide is introduced later on during your IVF cycle to manage ovulation. We start using cetrotide when the follicles reach a certain size. This is why we ask for a number of scans during your cycle. Timing consistency is also important for cetrotide. You need to inject cetrotide around the same time on the dates specified on your calendar.  Cetrotide is used instead of the lucrin/lupron/prostap depot injection. Cetrotide is a GnRH antagonist medication, preferred in women who have lowered ovarian reserves or women with PCOS.

IVF medication can be sub-cutaneously administered, which means, they are administered right under the skin. The following video explains how gonal-f injection can be mixed, adjusted for dosage and administered.